I have had several patients that require an AVR and have concomitant mitral regurgitation.  Usually, a double valve procedure is performed.  Although, when the patient has multiple co-morbidities and a poor EF,  an option is a Trans-Aortic Alfieri Stitch. I have performed 10 cases in which I have provided this option.  A good solution to a difficult problem.  I have submitted an early paper for publication.  I will keep you updated with the mid-term results.

intra-op view